MEDICARE: LIFESTYLE RX WELLNESS CLINIC LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP2300X	Primary Care Nurse Practitioner

General Provider Information

NPI Number	:	1750234605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LIFESTYLE RX WELLNESS CLINIC LLC

Provider Business Mailing Address
First Line	:	113 MILL PLAIN RD # 1104
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06811-5277
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7 SHANNON RIDGE ROAD
Second Line	:
City	:	DANBURY
State	:	CT
Zip	:	06810
Country	:	US
Telephone Number	:	203-770-5698
Fax Number	:

Authorized Official
Title or Position	:	OWNER & FNP
Name	:	ANWAR ESAM ABDULREHMAN
Credential	:	MSN, APRN, FNP-C
Telephone Number	:	203-770-5698

Provider Enumeration Date	:	02/19/2026
Last Update Date	:	05/04/2026

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